A recent global study has found that surgery should be delayed for at least seven weeks after a patient tests positive for COVID-19, noting that any operation taking place within six weeks after diagnosis can result in an increased risk of death.

According to researchers, patients are at least two-and-a-half times more likely to die after surgery if the medical procedure takes place within six weeks of a positive diagnosis for SARS-CoV-2. The study has been led by experts at the University of Birmingham. More than 25,000 surgeons have worked together under the COVIDSurg Collaborative to collaborate data from 140,727 patients from 1,674 hospitals across 116 countries, including China, the USA, the UK, Australia, Brazil, India, and the UAE, resulting in the creation of one of the world’s largest and broadest studies on surgery.

 The findings of the study have been published in Anaesthesia. As per the findings, patients operated within 0-6 weeks after a positive diagnosis for SARS-CoV-2 were at a higher risk of postoperative death. Patients with ongoing symptoms at the time of surgery were also at an increased risk of death, the study revealed.

Speaking over the development, co-lead author Dr. Dmitri Nepogodiev (from the University of Birmingham) recommended that, if possible, surgery should be delayed for at least seven weeks after a positive SARS-CoV-2 test result or until the symptoms are gone if patients have ongoing symptoms after 7 weeks or more after diagnosis.

Co-lead author Mr. Aneel Bhangu, from the University of Birmingham, added that the decision to delay surgery varies from patient to patient, underlining the significant advantages of a minimum seven-week delay after COVID-19 diagnosis to balance out any potential risks.

"For some urgent surgeries, for example for advanced tumors, surgeons and patients may decide that the risks of delay are not justified," Mr. Bhangu noted.

It is already well-known that COVID-19 infection during surgery increases mortality and international guidelines have also recommended delaying surgery for patients having a positive diagnosis for COVID-19. But there was not enough evidence for the optimal duration of delay in surgery.

In the study conducted in October 2020, participating hospitals helped in including all patients undergoing a surgical procedure, while patients who became infected with SARS-CoV-2 after their surgery were excluded. The primary outcome measure was 30-day postoperative death.

The study used statistical modeling to adjust for the patient, disease, and operation variables. Later, adjusted 30-day mortality rates were calculated for different periods from SARS-CoV-2 diagnosis to surgery.

Results showed the time to surgery from SARS-CoV-2 diagnosis was:

·    0-2 weeks in 1,144 (0.8%)

·    3-4 weeks in 461 (0.3%)

·    5-6 weeks in 327 (0.2%)

·    7 weeks or more in 1,205 (0.9%)

Meanwhile, 137,590 (97.8%) did not have SARS-CoV-2 infection. Furthermore, adjusted 30-day mortality in patients who were not infected by COVID-19 was 1.5%. It increased in patients operated at 0-2 weeks (4.0%), 3-4 weeks (4.0%), and 5-6 weeks (3.6%), but not at 7-8 weeks (1.5%) after SARS-CoV-2 diagnosis.

Significantly, these findings were consistent across various age groups but differed as per the severity of the condition of the patients, the urgency of surgery, the grade of surgery, and sensitivity analyses for elective surgery. It was observed that after a delay of seven weeks or more, patients with ongoing COVID-19 symptoms (6.0%) had increased mortality compared to patients whose symptoms were cleared (2.4%) or who were asymptomatic (1.3%).

Dr. Sattar Alshryda from Al Jalila Children’s Specialty Hospital and Dr. Hayder Al Saadi from Rashid Hospital were the UAE leads for the study. They explained that 13 centers and more than 40 researchers participated in the study with the contribution of more than 1000 participants. The study was supported by the Dubai app Healthcare City (DHCC), Ministry of Health, Dubai Health Authority (DHA), the Department of Health-Abu Dhabi, and Sharjah.

With this collaboration of relevant entities, the foundation to a new network of orthopedic researchers was laid down under the provisional name of U-TORCH - United Arab Emirates Trauma and Orthopaedic Research Champions. The network has been established with the aim of fostering nationwide, high-quality research across the country.

WAM